title: Nursing practice in stroke rehabilitation: systematic review and meta-ethnography.
abstract: OBJECTIVE
  To identify and synthesise the available research evidence in order to generate an explanatory framework for nursing practice in stroke rehabilitation.
  
  
  BACKGROUND
  Although nurses are the largest professional group working with stroke survivors, there is limited understanding of nursing practice in stroke units. In particular, there is currently very little evidence in respect of nurses' involvement in poststroke rehabilitation.
  
  
  METHODS
  Meta-ethnography.
  
  
  METHODS
  A systematic review was undertaken. The review question was: 'What is the nature of nursing practice in the care and rehabilitation of inpatient stroke survivors?' Searches of 12 electronic databases identified 14,655 publications, and after screening, 778 remained; 137 papers were obtained and 54 retained for mapping. Sixteen qualitative studies were included in the meta-ethnography.
  
  
  RESULTS
  Nurses' involvement in poststroke rehabilitation was limited. Contextual factors impacted on nurses' perceptions and practice. Nurses' integration of rehabilitation skills was perceived to be contingent on adequate nurse staffing levels and management of demands on nurses' time. Team working practices and use of the built environment indicated separation of nursing and therapy work. Physical care and monitoring were prioritised. Stroke-specific education and training was evident, but not consistent in content or approach. Stroke survivors and families needed help to understand nurses' role in rehabilitation.
  
  
  CONCLUSIONS
  The review provides compelling evidence that there is an need to re-examine the role of nurses in contributing to poststroke rehabilitation, including clarifying when this process can safely begin and specifying the techniques that can be integrated in nurses' practice.
  
  
  CONCLUSIONS
  Integrating stroke-specific rehabilitation skills in nurses' practice could contribute substantially to improving outcomes for stroke survivors. The explanatory framework developed from the review findings identifies issues which will need to be addressed in order to maximise nurses' contribution to the rehabilitation of stroke survivors.
authors.affiliation: Academic Unit of Elderly Care and Rehabilitation, Bradford Institution for Health Research, Bradford and Lecturer, School of Healthcare, University of Leeds, Leeds, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Clarke
mesh_terms: D000884:Anthropology, Cultural; D006801:Humans; D024802:Nurse's Role; D019145:Rehabilitation Nursing / Q000458:organization & administration*; D020521:Stroke / Q000208:ethnology / Q000451:nursing*; D000071939:Stroke Rehabilitation
keywords: multidisciplinary team working; nursing; rehabilitation; stroke; stroke unit